12/11 ZEKE AMPS 302; PMPS 373; +2.5=283; +4.25=288 FAIL ?

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MrZ

MrZ

Member Since 2013
Good Morning LL ~O) ~O) ~O) ~O)

Well, the last two days we've been waiting for Zeke to clear his bounces in order to evaluate the success of his recent back-to-back reduction to 1.5u. Here's a summary recap:

12/8: AMPS 165; +6.25 = 496; PMPS 324; +9.5 = 102
12/9: AMPS 106; +9.25 = 337 (No drop this whole cycle; Looks to me like bounce from yesterday's huge drop); PMPS 326; +6.25 = 82 (expect a bounce tomorrow due to huge drop)
12/10: AMPS 178; +6 = 356 (No drop this cycle; Looks to me like bounce from yesterday's huge drop); PMPS 358; +3.75 = 210 (finally a drop after a bounce. Thought he had clear bounce but numbers rose from there); +9.5 = 239
12/11 AMPS 302 (What? Why up? No reason for bounce in my opinion). Oh, oh: +2 = 319

So, I'm thinking that if I don't see any greens in this morning's cycle I should call it a fail and go back up to the s1.75u. Your thoughts please?

Previous Condo

Thanks,
Laura and Zeke
 
Re: 12/11 AMPS 302 - Failed Reduction

I don't think I'd call it a fail yet. You saw green last night. And it looks like a bounce today.

If his PMPS is lower than he is right now, I don't think I'd increase tonight. I think I'd see if the bounce clears.

Overall, he seems to like green more in the PM than during the AM cycles. If you are considering an increase, I think I'd wait for an AM cycle?
 
Re: 12/11 AMPS 302; +2 = 319 - Failed Reduction

Thanks Carl for popping in. No, Zeke did not have any greens last night. In fact he was flat yellow which to me would indicate he had cleared the bounce. Looks like you didn't have the benefit of the +2 before your post - don't know if that makes any difference to you or not but thought I'd mention.

My DH did the shot this morning. If it had been me and I had seen that 302 after last night's flat yellows I would have increased. However you make a very valid point that Zekey typically goes lower in the PM cycles. However, I don't want to prolong regaining the momentum we had on the higher dose so I'm inclined to increase this PM if we don't see some decreasing numbers at some point in this cycle.

As we all know the protocol states that one should go back up to the last good dose (s1.75u, for Zeke) after a failed reduction but perhaps if his PMPS is less 200 but not less than 130 (under 130, I would hold the 1.5u), I could just increase to a fat 1.5u this PM. As I've been told several times, the Protocol is not hard and fast rules so maybe this slight variation would be ok.

Thoughts, advice or concerns?
 
Re: 12/11 AMPS 302; +2 = 319 - Failed Reduction

Laura,
I missed last night. I was off by 24 hours (did you just update the SS?)

My point with the AM vs. PM was - if he regularly goes lower at night, and you increased at PM, then a good PM cycle might leave you guessing if the good numbers were due to the increase, or if Zeke was just doing his "normal" PM cycle routine.

As far as tonight goes...
I think it would depend on the way this cycle goes. If he is flat all day, or rising, then a full increase might be good. But if he is definitely "falling" towards PMPS, then maybe hold off until the morning? I never shot fat or skinny doses with PZI, so I don't know how much of a difference there is between a f1.5 and a s1.75.
 
Re: 12/11 ZEKE AMPS 302; +2 = 319 - Failed Reduction

I agree with Carl. I think this is a bounce from 2 nights ago.

Also, seeing a pre-shot number that's higher than what you want is not what you should look at in order to decide if an increase is needed. Remember, with Lantus (and Lev), dose changes are based on the nadir. For example, If I looked at Gabby's pre-shot last night, I'd have increased. Her nadir was in the greens. It is entirely possible for a cat to be in the 400s at both AMPS and PMPS and the nadir to be in the 40s. If you made a decision based on the pre-shot, you'd increase. If you base your decision on the nadir, you'd decrease. I'm not saying this is necessarily the case with Zeke. I'm reacting to your comment about seeing where the pre-shot value today is. It's challenging, at times, when it comes to differentiating between a failed reduction and a bounce especially if the rise in numbers occurs relatively slowly.
 
Re: 12/11 ZEKE AMPS 302; +2 = 319 - Failed Reduction

he's still bouncing. i'd wait.

i'd guess the reason Carl thought it was last night was partially because you didn't have a condo yesterday, so the link goes to 12/9, where there is a lot of discussion about it and Zeke was in the 70-80-90's for at least 6 hrs in the pm cycle.

He's got an every other day nights in the greens pattern going. i'd see what he does tonight.

the thing about a bounce is that it can look different ways at different times in the same cat. that's why people have a hard time learning what they look like. in this case, Zeke didn't fully clear it yesterday (only down to yellow numbers) and is still on it today. The bounce can hover around high, bobbling about sometimes.

Let's look at yesterday morning. He started at 178 with the beginning of his bounce from those lovely greens during the night. he rose consistently until pmps of 358, then wobbled around in the 200's last night, still showing you the pink numbers this morning. that's what's telling you that he hasn't cleared it. I would be surprised if he's not in greens again tonight.

the really important thing to see is that a bounce is not an indication of not enough insulin. it's liver response to the insulin getting the kitty into better numbers than they are used to. those are two very different things.
 
Re: 12/11 AMPS 302; +2 = 319 - Failed Reduction

So far today, Zeke is flat pink and rising. I'm unsure at this point what to do tonight once I have that preshot number. I liked your comment about Zeke going green during the PM cycle so if I increase tonight and he does go green, I won't know whether or not that would have occurred even without the increase. That's a good point to consider and an approach I'm understanding you to imply would be followed despite the PMPS number - is this correct? Basically, let's just try it and see what happens.

However, you also said :

Carl & Bob (GA) said:
Laura,

As far as tonight goes...
I think it would depend on the way this cycle goes. If he is flat all day, or rising, then a full increase might be good.
Click to expand...


So far he's just rising. If come preshot he is NOT falling, might it be best to hold to see if he'll go green on this dose or would it be better to increase tonight (as you've posted above as an option) and not risk having him stay in high numbers any longer?
 
Re: 12/11 ZEKE AMPS 302; +2 = 319; +6 = 361 - Failed Reducti

Just my opinion...
If he's falling, I would hold. If he's rising, provided you can test around +3 or +4, you could increase.

If you look back at what Julie and Sienne said earlier, the increase or decrease decision has a lot more to do with the nadir numbers than the preshot numbers. What I think might be important with the PS numbers is whether they show a rising or falling number when you give the shot.

A dropping number at PMPS could indicate that the bounce is "breaking", in which case you might not want to increase the dose and give a larger amount of insulin on a falling number. That could make for a long and exciting night. ;-)
 
Re: 12/11 ZEKE AMPS 302; +2 = 319; +6 = 361 - Failed Reducti

I think I agree with Julie and suggest you wait to see what Zeke does tonight before increasing. The other complicating thing that cats can sometimes do is to go high before they go low. For an example, see 11/27 on Zeke's SS. To me it feels like they are building up momentum for a really good drop. When I see pinks on Neko during the day, it tells me I should get a nap in that evening because there's likely to be green that night.
 
Re: 12/11 ZEKE AMPS 302; +2 = 319; +6 = 361 - Failed Reducti

exactly, wendy! punkin used to do that same thing - i thought of it as taking a gigantic inhale while it built up over multiple cycles, then he would jump off the cliff with his BGs plummeting. crazy. it didn't always do that, but enough that i started to recognize it when it was building up.
 
Re: 12/11 ZEKE AMPS 302; PMPS 373; +2.5=283; +4.25=288 FAIL

This is a fail isn't it? Looks to me like the best he can do on 1.5u is yellow (and not even for that long).
 
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